Title of Thesis

Socio-cultural factors affecting anemia and its effects on mother child health in the rural areas of district Faisalabad, Punjab, Pakistan

Author(s)

Zahira Batool

Abstract
Anemia a common blood disorder occurs when the level of healthy red blood cells (RBCs) in the body becomes too low. This can lead to health complications because red blood cells contain hemoglobin, which pass through oxygen to the body’s tissues. Anemia causes a variety of complications, including fatigue and stress on bodily organs. Anemia status can be affected by nutritional deficiencies, infectious diseases, genetic disorders, reproductive complications, and poverty. Anemia affects approximately 2 billion people at worldwide but disproportionately affects women and children. Women of reproductive age (15-49) in Pakistan are 68 million and 50 percent of them are anemic. Children under 5 years are 18 % of population and 45-60 percent are anemic due to poor diet. This study has identified factors of anemia, and its effect on mother and child health. The main objective was to investigate mother and child anemia conditions within sociocultural, demographic and nutritional context and effect of anemia on mother child health.
Cross-Sectional study was conducted in rural areas of District Faisalabad, Punjab, Pakistan. Both quantitative and qualitative methods (Triangulation) were used to get meaningful detailed information. For capturing maximum variation on socio-cultural, demographic and nutritional aspects, the study was conducted in all four rural towns of the district Faisalabad. This research design enhances the scope of study regarding generalization of research findings. A random sample of 400 (25 women from each village) mothers aged 18-49 with at least one child (under five year) was taken to explore the research objectives through pre-designed interviewing schedule with open and closed ended questions. In qualitative study detailed information through 8 focus group discussion of 4-12 women were collected. A blood sample was obtained from mothers and their last child to determine hemoglobin levels.
Univariate, bivariate and multivariate analysis demonstrate that education, family type, income, attitudes towards health facilities, violence, smoking, pre and postnatal care, blood loss during abortion, pica and calories intake were found to be associated with symptoms of anemia and level of hemoglobin of mother and child. The prevalence of anemia was found 33.3 (hemoglobin >9.0g/dl), 42.3 (hemoglobin 9.0-11.0 g/dl) and 11.1 (hemoglobin <11.1 g/dl) percent of the respondent had mild/normal, moderate and severe whereas 20.0 (hemoglobin >8.5g/dl), 41.8 (hemoglobin 8.6-10.0 g/dl) and 38.8 (hemoglobin <10.1g/dl) percent of children had mild, moderate, and severe anemia. With the increase of education of mother, family income symptoms of anemia decreased and level of hemoglobin increased both for the mother and child. Gender preferences, attitudes towards health facilities, smoking and violence were also found significant.Among these variables effect of violence on reproductive health caused a severe increase in symptoms of anemia and with decreasing level of hemoglobin. Age at marriage, prepostnatal care was negatively associated with symptoms of anemia and positively associated with level of hemoglobin. Whereas blood loss and communicable variables were positively associated with symptoms of anemia and negatively associated with level of hemoglobin in both of mother and child. Consumption of calories intake per day and pica habits were marginally associated with both of the symptoms of anemia and level of hemoglobin. Education, pregnancy history, iron supplementation, information on nutritional knowledge, attitudes, and practice and dietary history regarding usual food intake per day were poorly appeared in study. Moreover, through focus group discussion,mostly women expressed that “they had no money, no proper food, no proper shelter, no permission for prenatal and postnatal care and husbands unquestioning loyalty create threatening environment and you (me researcher) are talking about health, think it yourself that you can find the answer, you can not find the answer”. In short it resulted in poor health condition of mothers and their children with moderate to sever anemia.
It is suggested that provision of female education, income generating opportunities and utilization of health facilities and awareness about causes of consequences of anemia, knowledge and preventive measures of anemia and importance of balanced diet are appropriate measures to enhance health status of mothers and children. Awareness about suitable age at marriage, adequate adoption of pre-postnatal care, immediate attention towards heavy blood loss (abortion, menstruation), provision of iron supplements and adverse complications of pica need special attention to control over anemia status of mother and child. Government should provide proper attention to eradicate widespread prevalence of communicable diseases especially, TB, diarrhea and acute respiratory infection. Sensitization of gender issue need special attention that husband should be make aware about the health complications of different types of violence against females and children.

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1.1 Anemia
1.2 Signs And Symptoms
1.3 Measurement Of Severity Of Anemia
1.4 Common Types Of Anemia
1.5 Anemia Factors
1.6 Primary Factors
1.7 Malnutrition/ Infection Cycle
1.8 Use Of Drugs
1.9 Need Of Balance Diet
1.10 Objectives Of The Study:
1.11 Theoretical Framework
1.12 Conceptual Framework
1.13 Hypothesis

2.1 Socio-economic Variables
2.2 Cultural Variables
2.3 Demographic Variables
2.4 Nutritional Variables

3.1 Introduction
3.2 Study Design
3.3 Study Area
3.4 Sample Size
3.5 Sampling Plan
3.6 Data Collection
3.7 Measurement Of Severity Of Anemia
3.8 Characteristics Of The Respondents
3.9 Some Aspects To Improve The Data Quality
3.10 Developing The Sensitive Questions
3.11 Sequence Of Questions
3.12 Coding
3.13 Time And Relevant Questions
3.14 Training And Field Supervision
3.15 Pilot Testing
3.16 Data Editing And Management
3.17 Analysis

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4.1 Socio-economic Characteristics Of The Respondents
4.2 Balance Diet And Gender Inequalities
4.3 Demographic And Cultural Factors And Anemia
4.4 Utilization Attitude Towards Health Facilities
4.5 Addiction
4.6 Violence

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5.1 Testing Of Hypothesis Exploring Relationship
5.2 Socio-economics Variables
5.3 Cultural Variables
5.4 Nutritional Variables
5.5 Demography Variables
5.6 Socio-economic Variables
5.7 Cultural Variables
5.8 Nutritional Variables
5.9 Demographic Variables
5.10 Part-c: Effects Of Anemia On Mother,child Health
5.11 Summary

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6.1 Multiple Linear Regression Model
6.2 Suitability Of Multiple Linear Regression

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7.1 What Is Focus Group Discussion?
7.2 Advantages Of Focus Group Discussion
7.3 Selection Process Of Participants And Location
7.4 Precession Of Focus Group Discussion
7.5 Beginning The Focus Group Discussion
7.6 Recording The Focus Group Discussion And Written Notes
7.7 Measures Adopted To Improve The Quality Of Data
7.8 Analysis Of Focus Group Discussion
7.9 Results And Discussions
7.10 Summary

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8.1 Socio-economic Variables
8.2 Cultural Variables
8.3 Demographic Variables
8.4 Nutritional Variables
8.5 Recommendations
8.6 Conclusions
8.7 Recommendations For Further Studies

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